New Patient Registration Forms

Please print the forms below, complete them and bring them to your consultation. This will save you time on the day of your first appointment. Thank you.

Medical Release Authorization

Please fill out the form below to authorize release of your child's medical information. Medical records sent to another provider for continuity of care do not have associated fees. This form must be complete and include the date and signature; we cannot process incomplete forms. After completing, you can fax or mail this form to our office. Medical Record reproduction fees for personal use are listed below:

  • $18.97 for base fee
  • $0.63 per page
  • $20.00 for CD of radiographs

Authorization Form for Release of Medical Records

Please sign & date this form before faxing or turning in to our office.